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General NPI Number Information
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NPI Number | 1942075650
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Entity Type | Individual
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Provider Name | DEVON PENNER DC
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Gender | Male
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Dates
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Enumeration Date | 11/22/2023
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 108 E PINE ST
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City | CALDWELL
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State | ID
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Zip | 83605-4836
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Country | US
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Telephone | 208-459-0858
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Fax |
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Provider Business Mailing Address
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Address Line | 1783 W BRENTON ST
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City | MIDDLETON
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State | ID
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Zip | 83644
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Country | US
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Telephone | 986-837-7884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | ACP-467
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIA-2324
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License Number State | ID
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